Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $12.88 / $29.51	Facility	26	$12.02	$12.88	$29.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $46.77 / $218.78	Professional		$34.67	$46.77	$218.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.85 / $48.98	Professional	26	$10.96	$15.85	$48.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.20 / $117.49	Professional	TC	$22.91	$30.20	$117.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $40.74 / $42.66	Facility	26	$39.81	$40.74	$42.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $104.71 / $128.82	Professional		$53.70	$104.71	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $31.62 / $39.81	Professional	26	$16.98	$31.62	$39.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $72.44 / $91.20	Professional	TC	$35.48	$72.44	$91.20
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $64.57 / $151.36	Professional		$39.81	$64.57	$151.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $20.42 / $51.29	Professional	26	$12.88	$20.42	$51.29
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $42.66 / $107.15	Professional	TC	$26.92	$42.66	$107.15
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $100.00 / $100.00	Facility	26	$40.74	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $74.13 / $281.84	Professional		$39.81	$74.13	$281.84
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $21.88 / $100.00	Professional	26	$14.13	$21.88	$100.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $36.31 / $251.19	Professional	TC	$25.12	$36.31	$251.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $93.33 / $112.20	Professional		$85.11	$93.33	$112.20
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $31.62 / $39.81	Professional	26	$27.54	$31.62	$39.81
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $64.57 / $75.86	Professional	TC	$57.54	$64.57	$75.86
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $42.66 / $42.66	Facility	26	$42.66	$42.66	$42.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $85.11 / $109.65	Professional		$74.13	$85.11	$109.65
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $32.36 / $40.74	Professional	26	$26.30	$32.36	$40.74
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $58.88 / $75.86	Professional	TC	$45.71	$58.88	$75.86
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $33.88 / $72.44	Professional		$13.80	$33.88	$72.44
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $50.12 / $93.33	Professional		$39.81	$50.12	$93.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $17.38 / $30.90	Professional	26	$14.13	$17.38	$30.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $31.62 / $60.26	Professional	TC	$25.70	$31.62	$60.26
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $87.10	Professional		$74.13	$74.13	$87.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $23.44 / $27.54	Professional	26	$23.44	$23.44	$27.54
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $51.29 / $60.26	Professional	TC	$51.29	$51.29	$60.26